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NPI Code Detail

MEDICARE: AMANDA DAWN BENNETT FNP-C

MEDICARE: AMANDA DAWN BENNETT FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN109910/AP1963AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558329862
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DAWN BENNETT FNP-C
Provider Business Mailing Address
First Line : 801 W REX ALLEN DR
Second Line :
City : WILLCOX
State : AZ
Zip : 85643
Country : US
Telephone Number : 520-766-5000
Fax Number : 520-384-5001
Provider Business Practice Location Address
First Line : 801 W REX ALLEN DR
Second Line :
City : WILLCOX
State : AZ
Zip : 85643-1129
Country : US
Telephone Number : 520-766-5000
Fax Number : 520-766-5001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 10/17/2011

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